Postural Drainage Therapy for Airway Clearance
POSTURAL DRAINAGE-
IT IS AN INTERVENTION FOR AIRWAY CLEARANCE IS A MEANS
OF MOBILISING SECRETION IN ONE MORE LUNG SEGMENTS TO
THE CENTRAL AIRWAYS BY PLACING THE PATIENT IN VARIOUS
POSITIONS SO GRAVITY ASSIST IN THE DRAINAGE PROCESS.
POSTURAL DRAINAGE THERAPY ALSO INCLUDES THE USE OF
MANUAL TECHNIQUES SUCH AS PERCUSSIO, SHAKING AND
VIBRATION.
Indication-
PATIENT WITH PULMONARY DISEASES THAT ARE
ASSOCIATED WITH INCREASED PRODUCTION OR VISCOSITY
OF MUCOUS SUCH AS CHRONIC BRONCHITIS.
PATIENT WHO ARE ON PROLONGED BED REST.
PATIENT WHO HAVE RECEIVED GENERAL ANAESTHESIA AND
WHO MAY HAVE PAINFUL INCISION THAT RESTRICT DEEP
BREATHING AND COUGHING.
ANY PATIENT WHO IS ON VENTILATOR.
REMOVE ACCUMULATED SECRETION FROM LUNGS.
PATIENT WITH ACUTE/CHRONIC LUNG DISEASE.
PATIENT WHO ARE GENERALLY VERY WEAK OR ELDERLY.
Contraindications-
NEVER ALLOW A PATIENT TO FORCE EXPIRATION.
EXPIRATION SHOULD BE RELAXED AND LIGHTLY
CONTROLLED.
DON'T ALLOW A PATIENT TO TAKE A HIGHLY PROLONGED
EXPIRATION.
DON'T ALLOW A PATIENT TO INITIATE INSPIRATION WITH THE
ACCESSORY MUSCLES AND THE UPPER CHEST.
ALLOW THE PATIENT TO PERFORM DEEP BREATHING FOR
ONLY 3OR 4 INSPIRATIONS AND EXPIRATIONS AT A TIME TO
AVOID HYPERVENTILATION.
RECENT NEUROSURGERY
SEVERE HYPERTENSION
UNSTABLE ANGINA
RECENT MYOCARDIAL INFARCTION
CARDIAC ARRHYTHMIA
PULMONARY EMBOLISM/PLEURAL EFFUSION
CONGESTIVE HEART FAILURE
PULMONARY OEDEMA
SEVERE HAEMOPTSIS
Manual techniques used
with postural drainage-
PERCUSSION
IT IS USED TO AUGMENT , MOBILISATION OF SECRETIONS BY
MECHANICALLY DISLODGING VISCOUS OR ADHERENT
MUCOUS FROM THE AIRWAYS. IT IS PERFORMED WITH
CUPPED HANDS. THE THERAPIST SHOULD TRY TO KEEP
SHOULDERS, ELBOW AND WRIST LOOSE.
PERCUSSION IS CONTINUED FOR SEVERAL MINUTES OR UNTIL
THE PATIENT NEEDS TO ALTER POSITION TO COUGH, THE
PROCEDURE SHOULD NOT BE PAINFUL OR
UNCOMFORTABLE.
VIBRATION-
ITS ANOTHER MANUAL TECHNIQUE OFTEN IS USED WITH
PERCUSSION TO HELP MOVE SECRETION TO LARGER
AIRWAYS. IT'S APPLIED ONLY DURING THE EXPIRATORY
PHASE AS THE PATIENT IS DEEP BREATHING.
VIBRATION IS APPLIED BY PLACING BOTH HANDS DIRECTLY
ON THE CHEST WALL (ONE ON TOP OF OTHER) AND
GENTLY COMPRESSING AND RAPIDLY VIBRATING THE
CHEST WALL.
THE VIBRATING ACTION IS ACHIEVED BY THE THERAPIST
ISOMETTRICALLY CONTRACTING THE MUSCLE OF UPPER
EXTREMITIES FROM SHOULDER TO HAND.
SHAKING-
IT IS MORE VIGOROUS FORM OF VIBRATION APPLIED DURING
EXHALATION. THE THERAPIST THUMB ARE LOCKED TOGETHER,
THE OPEN HANDS ARE PLACED DIRECTLY ON THE PATIENTS
CHEST WALL. THE THERAPIST SIMULTANEOUSLY COMPRESS AND
SHAKES THE CHEST WALL.
Postural drainage
positions-
RIGHT AND LEFT UPPER LOBES-
1.ANTERIOR APICAL SEGMENT-
PLACE THE PATIENT IN HIGH
SITTING POSITION WITH BACK RESTING ON A PILLOW.
PERCUSSION IS APPLIED DIRECTLY UNDER THE CLAVICLE.
2.POSTERIOR APICAL SEGMENT-
FORWARD LEAN SITTING
POSITION IS ASSUMED BY THE PATIENT. PERCUSSION IS APPLIED
ABOVE THE SCAPULA FINGERS CURVE OVER THE TOP OF
SHOULDERS.
3.ANTERIOR SEGMENT-
PLACED THE PATIENT IN SUPINE
POSITION. PERCUSSION IS APPLIED BILATERALLY DIRECTLY
OVER THE CHEST.
4.LEFT POSTERIOR SEGMENT-
PATIENT LIES FLAT AND ONE QUARTER TURN FROM PRONE ON
THE RIGHT SIDE. PERCUSSION IS APPLIED DIRECTLY OVER THE
LEFT SCAPULA.
5.RIGHT POSTERIOR SEGMENT-
PATIENT LIES FLAT AND ONE QUARTER TURN FROM PRONE ON
THE LEFT SIDE. PERCUSSION IS APPLIED DIRECTLY OVER THE
RIGHT SCAPULA.
6.LINGULA SEGMENT-
PATIENT LIES QUARTER TURN FROM SUPINE ON THE RIGHT SIDE
SUPPORTED WITH PILLOW IN A 30° HEAD DOWN POSITION.
PERCUSSION IS APPLIED UNDER THE LEFT CHEST AREA.
7.MIDDLE LOBE-
PATIENT LIES QUARTER TURN FROM SUPINE ON THE LEFT SIDE
SUPPORTED WITH PILLOWS BEHIND THE BACK IN A 30° HEAD
DOWN POSITION. PERCUSSION IS APPLIED UNDER THE RIGHT
CHEST AREA.
RIGHT AND LEFT LOWER LOBES-
1.ANTERIOR SEGMENT-
PATIENT LIES SUPINE WITH PILLOWS UNDER THE KNEE IN A 45°
HEAD DOWN POSITION. PERCUSSION IS APPLIED BILATERALLY
OVER THE LOWER PORTION OF THE RIBS.
2.POSTERIOR SEGMENT-
PATIENT LIES PRONE WITH A PILLOW UNDER THE ABDOMEN IN A
45°HEAD DOWN POSITION. PERCUSSION IS APPLIED DIRECTLY
OVER THE LOWER PORTION OF THE RIBS.
3.LEFT LATERAL SEGMENT-
PATIENT LIES ON THE RIGHT SIDE IN A 45° HEAD DOWN
POSITION. PERCUSSION IS APPLIED OVER THE LOWER LATERAL
ASPECT OF THE LEFT RIB CAGE.
4.RIGHT LATERAL SEGMENT-
PATIENT LIES ON THE LEFT SIDE IN 45° HEAD DOWN POSITION.
PERCUSSION IS APPLIED OVER THE LOWER LATERAL ASPECT OF
THE RIGHT RIB CAGE.
5.SUPERIOR SEGMENT-
PATIENT LIES PRONE WITH A PILLOW UNDER THE ABDOMEN TO
FLATTEN THE BACK. PERCUSSION IS APPLIED BILATERALLY
DIRECTLY BELOW THE SCAPULA.
General
instructions/Precautions-
TIME OF DAY-
NEVER ADMINISTERED POSTURAL DRAINAGE DIRECTLY
AFTER MEAL.
CHOOSE A RIGHT TIME OF DAY HAVE MOST BENEFITS FOR
PATIENT. A PATIENT’S COUGH TENDS TO BE HIGHLY
PRODUCTIVE IN EARLY MORNING BECAUSE OF
ACCUMULATION OF SECRETION FROM THE RIGHT BEFORE
THE POSTURAL DRAINAGE IN THE EARLY EVENING CLEARS
THE LUNGS PRIOR TO SLEEP IN AND HELPS PATIENT REST
MORE EASILY.
COORDINATE TREATMENT WITH AEROSOL THERAPY.
SOMETIMES AEROSOL COMBINED WITH HUMIDIFICATION.
PRIOR TO POSTURAL DRAINAGE HELPS LOOSEN SECRETION.
FREQUENCY OF TREATMENT-
THE FREQUENCY OF POSTURAL DRAINAGE EACH DAY OR
DURING THE WEEK DEPENDS ON THE TYPE AND SEVERITY OF THE
PATIENT PATHOLOGY. IF SECRETION ARE THICK AND COPIUS, 2-
4 TIMES PER DAY MAY BE NECESSARY UNTIL THE LUNGS ARE
CLEAR. IF THE PATIENT IS ON MAINTENANCE PROGRAM THE
FREQUENCY IS LESS PERHAPS ONCE A DAY OR ONLY A FEW
DAYS PER WEEK.
Postural drainage therapy is an intervention used for airway clearance by mobilizing secretions in specific lung segments towards the central airways. It involves placing the patient in various positions to facilitate gravity-assisted drainage. The therapy includes manual techniques such as percussion, shaking, and vibration. It is beneficial for patients with pulmonary diseases associated with increased mucus production, those on prolonged bed rest, post-anesthesia patients, ventilated patients, and those with acute or chronic lung diseases. However, there are contraindications such as recent myocardial infarction, cardiac arrhythmia, pulmonary embolism, congestive heart failure, pulmonary edema, and severe hemoptysis. Manual techniques like percussion help dislodge mucus from the airways, while vibration assists in moving secretions to larger airways. Shaking is a more vigorous form of vibration applied during exhalation.
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Presentation Transcript
POSTURAL DRAINAGE- IT IS AN INTERVENTION FOR AIRWAY CLEARANCE IS A MEANS OF MOBILISING SECRETION IN ONE MORE LUNG SEGMENTS TO THE CENTRAL AIRWAYS BY PLACING THE PATIENT IN VARIOUS POSITIONS SO GRAVITY ASSIST IN THE DRAINAGE PROCESS. POSTURAL DRAINAGE THERAPY ALSO INCLUDES THE USE OF MANUAL TECHNIQUES SUCH AS PERCUSSIO, SHAKING AND VIBRATION.
Indication- PATIENT WITH PULMONARY DISEASES THAT ARE ASSOCIATED WITH INCREASED PRODUCTION OR VISCOSITY OF MUCOUS SUCH AS CHRONIC BRONCHITIS. PATIENT WHO ARE ON PROLONGED BED REST. PATIENT WHO HAVE RECEIVED GENERAL ANAESTHESIA AND WHO MAY HAVE PAINFUL INCISION THAT RESTRICT DEEP BREATHING AND COUGHING. ANY PATIENT WHO IS ON VENTILATOR. REMOVE ACCUMULATED SECRETION FROM LUNGS. PATIENT WITH ACUTE/CHRONIC LUNG DISEASE. PATIENT WHO ARE GENERALLY VERY WEAK OR ELDERLY.
Contraindications- NEVER ALLOW A PATIENT TO FORCE EXPIRATION. EXPIRATION SHOULD BE RELAXED AND LIGHTLY CONTROLLED. DON'T ALLOW A PATIENT TO TAKE A HIGHLY PROLONGED EXPIRATION. DON'T ALLOW A PATIENT TO INITIATE INSPIRATION WITH THE ACCESSORY MUSCLES AND THE UPPER CHEST. ALLOW THE PATIENT TO PERFORM DEEP BREATHING FOR ONLY 3OR 4 INSPIRATIONS AND EXPIRATIONS AT A TIME TO AVOID HYPERVENTILATION. RECENT NEUROSURGERY
RECENT MYOCARDIAL INFARCTION CARDIAC ARRHYTHMIA PULMONARY EMBOLISM/PLEURAL EFFUSION CONGESTIVE HEART FAILURE PULMONARY OEDEMA SEVERE HAEMOPTSIS
Manual techniques used with postural drainage- PERCUSSION IT IS USED TO AUGMENT , MOBILISATION OF SECRETIONS BY MECHANICALLY DISLODGING VISCOUS OR ADHERENT MUCOUS FROM THE AIRWAYS. IT IS PERFORMED WITH CUPPED HANDS. THE THERAPIST SHOULD TRY TO KEEP SHOULDERS, ELBOW AND WRIST LOOSE. PERCUSSION IS CONTINUED FOR SEVERAL MINUTES OR UNTIL THE PATIENT NEEDS TO ALTER POSITION TO COUGH, THE PROCEDURE SHOULD NOT BE PAINFUL OR
VIBRATION- ITS ANOTHER MANUAL TECHNIQUE OFTEN IS USED WITH PERCUSSION TO HELP MOVE SECRETION TO LARGER AIRWAYS. IT'S APPLIED ONLY DURING THE EXPIRATORY PHASE AS THE PATIENT IS DEEP BREATHING. VIBRATION IS APPLIED BY PLACING BOTH HANDS DIRECTLY ON THE CHEST WALL (ONE ON TOP OF OTHER) AND GENTLY COMPRESSING AND RAPIDLY VIBRATING THE CHEST WALL. THE VIBRATING ACTION IS ACHIEVED BY THE THERAPIST ISOMETTRICALLY CONTRACTING THE MUSCLE OF UPPER EXTREMITIES FROM SHOULDER TO HAND.
SHAKING- IT IS MORE VIGOROUS FORM OF VIBRATION APPLIED DURING EXHALATION. THE THERAPIST THUMB ARE LOCKED TOGETHER, THE OPEN HANDS ARE PLACED DIRECTLY ON THE PATIENTS CHEST WALL. THE THERAPIST SIMULTANEOUSLY COMPRESS AND SHAKES THE CHEST WALL.
Postural drainage positions- RIGHT AND LEFT UPPER LOBES- 1.ANTERIOR APICAL SEGMENT-PLACE THE PATIENT IN HIGH SITTING POSITION WITH BACK RESTING ON A PILLOW. PERCUSSION IS APPLIED DIRECTLY UNDER THE CLAVICLE. 2.POSTERIOR APICAL SEGMENT-FORWARD LEAN SITTING POSITION IS ASSUMED BY THE PATIENT. PERCUSSION IS APPLIED ABOVE THE SCAPULA FINGERS CURVE OVER THE TOP OF SHOULDERS. 3.ANTERIOR SEGMENT-PLACED THE PATIENT IN SUPINE POSITION. PERCUSSION IS APPLIED BILATERALLY DIRECTLY OVER THE CHEST.
4.LEFT POSTERIOR SEGMENT- PATIENT LIES FLAT AND ONE QUARTER TURN FROM PRONE ON THE RIGHT SIDE. PERCUSSION IS APPLIED DIRECTLY OVER THE LEFT SCAPULA. 5.RIGHT POSTERIOR SEGMENT- PATIENT LIES FLAT AND ONE QUARTER TURN FROM PRONE ON THE LEFT SIDE. PERCUSSION IS APPLIED DIRECTLY OVER THE RIGHT SCAPULA. 6.LINGULA SEGMENT- PATIENT LIES QUARTER TURN FROM SUPINE ON THE RIGHT SIDE SUPPORTED WITH PILLOW IN A 30 HEAD DOWN POSITION. PERCUSSION IS APPLIED UNDER THE LEFT CHEST AREA. 7.MIDDLE LOBE- PATIENT LIES QUARTER TURN FROM SUPINE ON THE LEFT SIDE SUPPORTED WITH PILLOWS BEHIND THE BACK IN A 30 HEAD
RIGHT AND LEFT LOWER LOBES- 1.ANTERIOR SEGMENT- PATIENT LIES SUPINE WITH PILLOWS UNDER THE KNEE IN A 45 HEAD DOWN POSITION. PERCUSSION IS APPLIED BILATERALLY OVER THE LOWER PORTION OF THE RIBS. 2.POSTERIOR SEGMENT- PATIENT LIES PRONE WITH A PILLOW UNDER THE ABDOMEN IN A 45 HEAD DOWN POSITION. PERCUSSION IS APPLIED DIRECTLY OVER THE LOWER PORTION OF THE RIBS. 3.LEFT LATERAL SEGMENT- PATIENT LIES ON THE RIGHT SIDE IN A 45 HEAD DOWN POSITION. PERCUSSION IS APPLIED OVER THE LOWER LATERAL ASPECT OF THE LEFT RIB CAGE.
4.RIGHT LATERAL SEGMENT- PATIENT LIES ON THE LEFT SIDE IN 45 HEAD DOWN POSITION. PERCUSSION IS APPLIED OVER THE LOWER LATERAL ASPECT OF THE RIGHT RIB CAGE. 5.SUPERIOR SEGMENT- PATIENT LIES PRONE WITH A PILLOW UNDER THE ABDOMEN TO FLATTEN THE BACK. PERCUSSION IS APPLIED BILATERALLY DIRECTLY BELOW THE SCAPULA.
General instructions/Precautions- TIME OF DAY- NEVER ADMINISTERED POSTURAL DRAINAGE DIRECTLY AFTER MEAL. CHOOSE A RIGHT TIME OF DAY HAVE MOST BENEFITS FOR PATIENT. A PATIENT S COUGH TENDS TO BE HIGHLY PRODUCTIVE IN EARLY MORNING BECAUSE OF ACCUMULATION OF SECRETION FROM THE RIGHT BEFORE THE POSTURAL DRAINAGE IN THE EARLY EVENING CLEARS THE LUNGS PRIOR TO SLEEP IN AND HELPS PATIENT REST MORE EASILY. COORDINATE TREATMENT WITH AEROSOL THERAPY.
FREQUENCY OF TREATMENT- THE FREQUENCY OF POSTURAL DRAINAGE EACH DAY OR DURING THE WEEK DEPENDS ON THE TYPE AND SEVERITY OF THE PATIENT PATHOLOGY. IF SECRETION ARE THICK AND COPIUS, 2- 4 TIMES PER DAY MAY BE NECESSARY UNTIL THE LUNGS ARE CLEAR. IF THE PATIENT IS ON MAINTENANCE PROGRAM THE FREQUENCY IS LESS PERHAPS ONCE A DAY OR ONLY A FEW DAYS PER WEEK.
